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APPLICATION FOR SANITATION PERMIT Permit No.�--��__1----- (Complete in Duplicate) 1 Date Issued a __-�-/-S-� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �� # JOBADDRESS AND LOCATION .. ------- � ------ ---------- ---------------------•--------------------------------------- Owner's Name------------------------- ------ Phone------------------------------------ A ress----------------------------------------------1-•-•------------------------------------------- ----------------------------------------•------------ --------------------------------------------------- Contractor's Name------------------------- ------------------- ------ Phone------------------•=--------------- t Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ;;}❑ Number of living units: __ ___ Number 9f bedrooms 2---Number of baths /------ Lot size _�__--1-_0_-f�___ ______________ Water Supply: Public system Immunity system '❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�a pan ❑ Previous Application Made: Yes ❑ No ew Construction: Yes [TL—N-C-� ; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from foundation___le Material_______________ __ - - -- -------- - No. of compartments--------4,�-•/,-----------Size_3_ __ _s�Liquid d pth___________ ______Capacity._--_ _�___ Disposal Field: Distance from nearest well--4/*#*Distance from foundation__—±P__ istance to nearest lot line____ --- -___.___-Length of each line_____- _ Width of trench__---� z 1� Number of lines----------- -- Type of filter material±�r_T_.�tDe th of filter material------- j_ _--- _Total length---------- __L� Seepage Pit: Distance to nearest well-________-_______ Distance from foundation--------------------Distance to nearest lot line----------- %1141 ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-_---------------------Depth--------------------------------- Cesspool: Distance from nearest well----------------_Distance from foundation--------------------Lining material____________---_____________---_____. ❑ Size: Mamefer----------------- ------------ -------Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- El Distance ____.______ ------_____:_______________- Distanceto nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):------ ------------------- -------------------•-----------------------------•----------------- ---------------------------------------------------------- ------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I hay prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ules and regulations of the San Joaquin Local Health District. Owner and/or Contractor By:---------------- --------------------------------- -- --------------------------------------------------------- ------(Title)------------------ -------------------------------------------- (Plot plan, showing size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY-------------------------- --------------------'------ ----------------------- DATE D rte_ I: REVIEWED BY----------------------------------- ------------------------------------------------ ---------------------------------------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterafions.And/or recommendations:----_---------------------------------------------- -- ��f/ D/4 ----------- -------------35-- ---------------------- --------------------�--------------------•---------------- I' l y a ------ --- -------- -`-- --------- -- ----•--- ------------ - ------- ---=----------------------=---- -- _- E ---------- ------ _ ____ _�_-__ _ �__-_ -_`____ _ ___ - -� -- __•�1�-}•.fit -__ ---- - --- ---- - ----- 4 FINALINSPECTION BY---------------- ----------------------------------------------- Date---------------------------------- '- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100